Transfus Apher Sci
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The epidemiology of red cell transfusion is changing. Surgical use has decreased due to reduced transfusion triggers and better operative techniques. ⋯ The evidence for and against transfusion at different levels of anaemia is discussed. The appropriate level of haemoglobin at which to recommend transfusion depends on the indication for transfusion, the patient's co-morbidities and the quality of the red cells available.
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This paper describes the history and pathogenesis of TRALI and illustrates this with personal experience of the condition over 15 years at a single hospital. It discusses the contribution of transfusion to ALI seen in critically ill patients, and the effect of preventative measures taken in the UK.
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More than 50% of all red cells are used to treat patients who are hemorrhaging either due to spontaneous bleeding, trauma or surgery and all platelet products and most plasma is given to prevent or treat bleeding patients. Therefore, knowledge of hemostasis is important to transfusion medicine specialists. There are three requirements to function in this capacity. One, understand the test used to assess hemostasis; two: understand the composition of blood components thoroughly and three, have a knowledge of the clinical studies in which hemostasis risk was assessed using tests of hemostasis and the clinical utility of blood components in bleeding risk attenuation.
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We investigated the effect of administering a transfusion package encompassing 5 red blood cells (RBC), 5 fresh frozen plasma (FFP), and 2 platelet concentrates (PC) on clot formation and stability as evaluated by Thrombelastograph (TEG) in 10 patients presenting with massive bleeding. Blood was obtained before and after administering the transfusion packages. ⋯ In 8 patients damage control surgery was successful and 6 of these patients survived. The result indicates that an early balanced transfusion strategy maintains haemostatic competence in massively bleeding patients.
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Transfusion-related acute lung injury (TRALI) is a serious adverse consequence of blood product transfusion. Cases of TRALI have gone unrecognized or misdiagnosed, since the symptoms can be confused with other transfusion-related events or with non-transfusion related comorbidities. Suspected cases of TRALI may be insufficiently investigated, and mild or moderate cases may not be investigated or reported at all. ⋯ A very few cases of TRALI have been described being caused by HLA class II antibodies without the simultaneous presence of anti-HLA class I antibodies. Technology for antibody detection has increased the power and the specificity, especially with the use of flow cytometry with a better definition of the antigen/antibody pairs that have resulted in TRALI episodes. In this sense, HLA class II antibodies can exactly be detected with these methods and have surely been underestimated until now.